Composite Shock Analysis in Sepsis

Sepsis is a life -threatening condition. When a human body is infected and it leads to an organ dysfunction, and often it causes death. Approximately 30% of people encountered severe sepsis do not survive. The only way to increase the mortality rate in sepsis is early detection .Sepsis development is detected using single failing vital sign .Instead shock develops when multiple organ system begin to become progressively worse together. In that way composite shock risk analysis helps to detect this difficulty by combining physiological marker into one combined risk score and prevent sepsis in the early stages.

Composite Shock Analysis

Composite Shock analysis is a process of analyzing severity of sepsis. This process   is used to evaluate how sepsis is developing shock and affects organ functioning. It is done by monitoring respiratory rate, etco2 and lactate. In this analysis evaluation reflects patient's hemodynamic and metabolic stability.

Biomarker Ideal Range

Biomarker	NORMAL RANGE
ETCO2	35 and 45 mmHg
Respiratory Rate	20 and 25  bpm
Lactate	0.5 to 1.5 mmol/L

 ETCO2

  End -tidal carbon dioxide (ETCO2) is measuring carbon dioxide is released by patients through metabolism (production of Co2, byproduct of cellular metabolism) perfusion (carrying analysis into the lungs), ventilation (Releasing CO2 through respiratory system).Prehospital provider use low ETCO2 as rapid screening tool to analysis identify sepsis and also in other way to trigger early intervention.

RESPIRATORY RATE

Respiratory rate is the number of breaths take per minute by a person. It helps us to find the intake of oxygen and release of carbon dioxide from human body.If respiratory rate change, then it is considered as earliest warning of sepsis . In this condition, the abnormalities in respiratory rate first indicates the need for additional patient assessment and immediate response to prevent further decline and unexpected cardiac arrest.

Lactate:

       Lactate is a metabolite of glucose produced by tissues in the body during insufficient oxygen supply. It reflects cellular dysfunction in sepsis patients. It is marker of tissue hypo perfusion when it rises to the level of 1.0mmol/L. In sepsis, increases lactate level indicates that severe illness, poor tissue oxygenation and changed metabolism.

 Generally Severe Sepsis is caused by poor perfusion, which elevates the level of serum lactate and it leads to metabolic acidosis. EtCO2 level decline when both poor perfusion and metabolic acidosis.Due to metabolic acidosis patients increases ventilation. This condition increases respiratory rate to rapidly eliminate excess carbon dioxide and decrease EtCO2 level . This shows that low EtCO2 correlates with lactate levels and anticipate mortality rate in patients with suspected sepsis, severe sepsis and septic shock. Eventually, poor tissue perfusion will reduce the amount of blood flow to the air sac of the lungs, so that reduce the release of carbon dioxide. During this process cardiac arrest also occur. It shows that as lactate levels rise in septic patients

Three Stages of shock risk analysis

Composite shock analysis has 3 stages of shock detected in sepsis patients. They are No shock , Early shock and High Shock risk detection corresponding to the hours.These three stages are detected through calculating the score by the values of biomarkers.If the composite score value is below 2 ,then it is considered as no shock detection. In the other case, if the value in between a 2 and 4 then the risk is early shock detection.The value is more than four, then risk detected is high shock risk.During early stages there is no shock . Later on in few cases were undergoes early shock detection. Early shock detection helps clinicians to determine patients who need immediate observation and treatment ,where the infection will not develop to the next level. High Shock risk develops in the later stages it can leads to severe sepsis and septic shock .

Difference Between Composite Shock Risk and Septic Shock

During sepsis, though shock risk analysis and Septic shock are sound alike and confusing.But Septic Shock is a critical condition where infection causes dangerously low blood pressure and organ failure. ,it leads to multi organ dysfunction and it increases the mortality rate.But high shock risk stage in composite shock risk analysis leads to severe sepsis. Severe sepsis is treated apathetic way then ,it can lead to septic shock. Septic Shock criteria are MAP <65mm where lactate serum will be elevated above 2 mmol/L then respiratory rate will be above 22 bpm and systolic blood pressure value will be in between 40 and 90 mmHg. As shown in below picture composite Shock have the mortality rate of 10% whether septic shock have mortality rate of 40%. To treat septic shock vasopressors given to maintain MAP and aggressive fluid resuscitation will be used.

Importance of Composite Shock risk

Patients who have vastly increasing composites score can be describe that they have highest mortality rate. Lactate level is increased with respiratory rate have strongest early shock identification . Composite scoring at earlier stages, use to detect high risk patients earlier than the single biomarker inception .Detecting earlier makes the composite shock risk analysis more powerful. It converts raw data into processed information that provides specific ,timely and relevant treatment . By integrating multi organ behavior into a single processed information ,composite shock risk analysis turns complex ICU data into improving sepsis outcomes through rapid decision making. It helps clinician to intervene earlier, use the resources effectively and reduce the preventable death.

Conclusion

As a conclusion, Composite shock risk analysis describes how advanced analytics can change critical care data into lifesaving informations. As healthcare moves towards predictive medicine ,composite models will become central to ICU.